Monday, September 28, 2009

A chance to reform the PATRIOT Act

The Electronic Frontier Foundation has a letter you can send to your senators to support the reform of the PATRIOT Act to curtail civil liberties abuses. It just takes a few minutes, and for Oklahoma residents, could be especially powerful, because our own Tom Coburn is a member of the Senate Judiciary Committee.

If our ultra-conservative senators are so suspicious of government and don't want it to curtail our liberties, maybe they'll support this. (Well, a person can hope.)

You can read the text of the JUSTICE Act here. The EFF explains the issues here.

Friday, September 25, 2009

Interesting, but not surprising

ProPublica talks about the incentive that Arkansas "Blue Dog" Democrat Mike Ross might have to oppose health care reform.
Arkansas Rep. Mike Ross -- a Blue Dog Democrat playing a key role in the health care debate -- sold a piece of commercial property in 2007 for substantially more than a county assessment and an independent appraisal say it was worth.

The buyer: an Arkansas-based pharmacy chain with a keen interest in how the debate plays out.

Ross sold the real estate in Prescott, Ark., to USA Drug for $420,000 -- an eye-popping number for real estate in the tiny train and lumber town about 100 miles southwest of Little Rock.

"You can buy half the town for $420,000," said Adam Guthrie, chairman of the county Board of Equalization and the only licensed real estate appraiser in Prescott.

But the $420,000 was just the beginning of what Ross and his pharmacist wife, Holly, made from the sale of Holly's Health Mart. The owner of USA Drug, Stephen L. LaFrance Sr., also paid the Rosses $500,000 to $1 million for the pharmacy's assets and paid Holly Ross another $100,001 to $250,000 for signing a non-compete agreement. Those numbers, which Ross listed on the financial disclosure reports he files as a member of Congress, bring the total value of the transaction to between $1 million and $1.67 million.

And that's not counting the $2,300 campaign contribution Ross received from LaFrance two weeks after the sale closed.

Holly Ross remains the pharmacist at Holly's Health Mart under USA Drug. Neither she nor her husband agreed to speak with ProPublica for this story. (Read Rep. Mike Ross's response to this ProPublica-Politico investigation.)

Tuesday, September 22, 2009

Republicans for Single Payer Care

This morning on Facebook, the Whole Foods Boycott Action posted a link to the web page of Republicans for Single Payer, who are promoting "Universal Health Care with Informed Choice." Exploring this site a little bit, I found a link to a plan for something called Balanced Choice Health Care which presents itself as the conservative version of single payer.

"Single payer" usually means HR 676 (unlike other proposals currently making their way through Congress, this bill is only 26 pages long, so its easy to just read the whole thing.)

Under HR 676, the system would be partly funded by eliminating paperwork and the bulk purchase of pharmaceuticals. Additional funding would come from "existing sources of Federal government funding for health care," from a tax on the top 5 percent of wage earners, from a modest payroll tax on workers, and from a small tax on stock and bond transactions. Private insurance companies would be forbidden to sell policies for any of the medically necessary procedures and medicines covered by the system. Patients would be free to choose their own doctors, and doctors would remain privately employed. There would be no deductibles or copays.

The Balanced Choice proposal has several differences.

For one thing, the funding is a bit different. It relies on current state and federal funding, on diverting current employer contributions into a trust fund, and also on what appears to be a payroll tax. The system would be managed by a private non-profit organization rather than by a government agency.

For another thing, patients would make some kind of out-of-pocket payment every time they went to the doctor. There would be two options. Under the copay option, patients would make a small co-pay most times they went to the doctor, and the rest of the payment would come from the system. The payment would be an agreed-upon amount, and the doctor couldn't charge more. Under the independent option, the system would make a basic payment to the doctor, and the patient would pay the difference between what the system provided and what the doctor charged. This would allow wealthy patients to pay more for premium services, and it would allow health care providers to profit by providing those services.

Finally, it seems that rather than having the government negotiate prices for drugs, the Balanced Choice proposal would use a different system that allowed patients, under their doctors' guidance, to choose medication that fit their needs and their budgets. (I'm a bit skeptical about this part of it, actually. It seems like a sop to the pharmaceutical industry, and I doubt it would do much to control costs.)

I think that the Balanced Choice program is an interesting idea. At first glance, it seems that it would do more to more to provide universal care and control costs than any of the plans currently under active consideration in the House and Senate. It would benefit workers, and also employers, who would be freed from the trouble of providing health insurance, and who would be promised cost savings over the current system. As I've noted above, it might make the pharmaceutical industry happy. It probably would make health insurance companies very unhappy, because it would put them out of business.

Furthermore, Balanced Choice is devised and promoted to answer the concerns that conservatives express about the kind of single-payer system envisioned in HR 676.
Providers have justifiably resisted the idea of a government-operated health care system. This is not an abstract ideological position, but one that is based on experience with government systems. Medicare has a history of unilaterally determining reimbursement rates that do not adequately reimburse some areas of health care. In the current system, providers can refuse Medicare patients because there are other sources of income. If there were only one system, it is natural to be concerned about having the profession crippled by misguided government policies. At times Medicare has also made heavy-handed threats of prosecution for fraud and huge fines when providers have made errors in following bureaucratic procedures. The Veterans Administration is known for bureaucratic inefficiency.

Balanced Choice is not this kind of government program. It protects providers from these abuses because it allows patients and providers to make choices. Providers are not locked into accepting the fee schedule and can use the Independent Option if the Copay Option reimbursements are insufficient. Balanced Choice would be required to distinguish between bureaucratic errors and fraudulent billing, and it would be prohibited from the heavy-handed threats of criminal prosecution that were used by Medicare. Balanced Choice is not a health care delivery organization; it is a payment system for independent providers of health care services.

Balanced choice might be a reasonable compromise between conservatives and progressives on the subject of health care. But given that the machinery of both the Democratic and Republican parties seem determined to protect private profit over the public good, I doubt it has much chance of gaining serious consideration.

What do you think?

Reform health care, not just insurance

Talking to Myself isn't really a health care blog, but it does seem that's most of what I'm blogging about these days. But this is an important issue, so here we go again. Over at Common Dreams, Randall Amster asks the thought-provoking question, Does Anyone in the Healthcare Debate Really Care About Health?

Amster argue persuasively that merely assuring access to the current system, with its emphasis on drugs and surgery, isn't going to make us any healthier.
What I'm suggesting may be difficult for some folks to accept. It has become convenient and comfortable for many people to rely on the current healthcare system. Prescriptions for painkillers and their ilk are glad-handed all over the country every day. Radical surgeries are performed routinely in non-life-threatening situations. Giving birth has been rendered an "illness" requiring hospitalization and, oftentimes, surgery if nature doesn't follow the predetermined clock precisely. Children are given full-spectrum vaccinations before they can even walk, and when they start to run are medicated psychotropically if they don't color within the approved lines. Emergency rooms are staffed by everyone except doctors (who still wind up billing you anyway) and are filled to the brim with people lacking true emergencies. And so on.

This is a sick system, and a sickening one too. Most of the reasons for entering the healthcare system could be attended to in myriad other ways that are healthier and more beneficial for individuals and society as a whole. Unfortunately, we've chosen to accept and subsidize in large measure one model of healthcare to the exclusion of competing options. How many plans in existence today provide coverage for midwives, naturopaths, nutritionists, masseuses, or the like? Even in the few cases where they might do so, how many people utilize these services in any event? Let's be real about this: our healthcare plans, and the ones being debated nationally right now, are overwhelmingly about the "pills and surgery" reactive version and hardly at all about proactive, natural options. The only talk even remotely along these lines is about preventive care, but even that becomes about screening and testing for conditions that then will likely require pills and surgery.
Amster describes health care systems in Japan and New Zealand, which he says work much better than ours. The entire essay is well worth reading.

Monday, September 21, 2009

Happy anniversary

Hat tip to the New Zealand blog In a Strange Land for linking to this post about the anniversary of women's suffrage in New Zealand. On Sept. 19, 1893, New Zealand became the first nation state to grant women the right to vote.

Friday, September 18, 2009

Finally, some common sense on the issue of health reform and "illegal immigrants"

Naomi Freundlich at Health Beat writes about Health Reform At The Expense of Immigrants.
“Under President Obama's plan, undocumented immigrants would not be allowed to enter the exchange. People who are lawfully present in this country would be able to participate in the exchange.”

That statement, which echoes a provision that is included in the newly-released Senate Finance Committee’s version of health reform, means that even undocumented workers who want to pay out of pocket for health insurance—with no government subsidy—will be denied access to the exchanges.

This is a short-sighted political move that is designed clearly to pander to the Conservatives who have dredged up the illegal immigrant issue (along with abortion and end-of-life counseling) in an attempt to block any version of health care reform. It won’t garner more support for reform legislation, it eliminates cost-savings and it moves us further from the stated goal of being a compassionate nation.

Freundlich points out that discouraging anyone from buying health insurance drives up the cost of health care for everyone by discouraging preventive care and encouraging expensive emergency room visits. Plus, the more stringent citizenship verification requirements in the Senate Finance Committee bill would drive up administrative costs.

I find myself wanting to quote a lot more of this clear-sighted and compassionate post. It's not very long. Why not read the whole thing for yourself?

Thursday, September 17, 2009

Senate Finance Committee releases health bill

The Senate Finance Committee has released its much-anticipated version of the health insurance reform bill. Committee Chair Max Baucus created a bi-partisan "gang of six" to try to create a bill that would gain Republican support--by, for instance, taking away the public option that would give private insurers some competition. Baucus has received widespread criticism for being the darling of the insurance companies--but he wasn't able to get any Republicans to support his bill.

Here's a link to download Baucus's Americas_Healthy_Future_Act.

Meanwhile, Washington Post blogger Ezra Klein has an interesting analysis of the Baucus bill.

Monday, September 14, 2009

How to get the money to pay for health care reform?

One thing that would help a lot would be to join Feminist Peace Network in the campaign We Need An Exit Strategy For Afghanistan NOW.
The Feminist Peace Network is participating in a week-long effort to demand an exit strategy for Afghanistan. While certainly believing that there should be accountability for the bombing of the World Trade Center and the many lives that were lost that day, the Afghan people were not responsible for what happened and the United States’ unending campaign to destroy Afghanistan that has cost so many Afghan lives has clearly failed to destroy the Taliban and is unsupportable and needs to end.

As this blog has pointed out countless times, despite the use of the human rights of women in Afghanistan as part of the justification for our actions, the lives of Afghan women remain at extreme peril and the continuing militarism only exacerbates the everyday dangers that they face. It is time not only to get out but to substantively provide the Afghan people and especially Afghan women with the means to rebuild their country. Doing so would make us all much safer.

Sunday, September 13, 2009

Singing (and marching) in the rain

An enthusiastic crowd of about 250 Oklahoma residents braved the rain to march on the state capitol today in support of efforts to reform our nation's out-of-whack health care system. The event was sponsored by the Oklahoma chapter of Organizing for America.

Speakers included Dr. Boyd Shook of Manos Juntas, 9-11 volunteer rescue worker Reggie Cervantes, the Rev. Jeff Hamilton, president of the Interfaith Alliance of Oklahoma, State Rep. Anastasia Pittman, State Sen. Constance Johnson, and the Rev. Robin Meyers of Mayflower UCC Church.

Boyd Shook told the demonstrators that the United States has the most expensive health care system in the world, but not the best. He said that US health care ranks 37th in the world in quality and value, and that a public insurance option would allow us to lower cost and increase quality.

Anastasia Pittman reminded her listeners that "sick children can't learn, and sick people can't earn." She said that Oklahoma ranks 10th in the nation in people without any health insurance, with 600,000 uninsured, and that 60 percent of bankruptcies were caused by medical expenses. Referring to the lack of support for health care reform by Oklahoma's US senators and representatives, Pittman asked, "Who are we voting for, and why are we voting for them?"

Everyone there seemed eager to jump into the difficult work of passing health care reform. Most seemed to favor a public option, and some signs supported the creation of a single payer system.

Saturday, September 12, 2009

March for Affordable Health Care

Sponsored by the Democratic lobbying group Organizing for America, there will be marches nationwide tomorrow to support President Obama's health care reform proposals.

These rallies are meant, in part, to counter right-wing anti-reform rallies that were held today.

The MARCH FOR HEALTHCARE- OKC will take place on the south steps of the state capitol, starting at noon tomorrow. It's preceded by a march, starting at 11:15 from Stiles Park at 8th and Stiles.

According to the Oklahoman, after the pro-health care march, an anti-reform group will be holding a rally on the north steps of the capitol starting at 4:30.

What happens when corporations own our free speech?

Hat tip to Ezra Klein for this link to The Life and Death of Online Communities, by Phoebe Connelly at The American Prospect.

Connelly discusses the demise of GeoCities, an old school community of user-created web pages that was popular back in the 1990s. Its owner, Yahoo, has announced that it will close GeoCities on October 26.

Other online platforms began to spring up, and soon GeoCities became a fond memory for most users. Blogger was introduced in 1999 (and purchased by Google in 2003), making it easy for anyone to start a blog. MetaFilter, a community blog, was launched in 1999. The social networking site My-Space was founded in 2003. These services also marked the entrance of a very public form of socializing--where, unlike email or listservs, the conversation, and content, was accessible to those not part of the conversation. In offering a platform for creating online identities, GeoCities started a trend that has been replicated by companies ever since.

But once those online identities are created, are they the property of the users or the corporations that host them? David Bollier, author of Viral Spiral: How the Commoners Built a Digital Republic of Their Own, calls corporate-controlled spaces like GeoCities and Facebook, "faux commons." For him, true online community spaces are defined by users having control over the terms of their interaction and owning the software or infrastructure. Corporate spaces come with "terms of service" agreements that lay out the rules users must abide by and what control they agree to surrender in exchange for using the product. "Oftentimes corporate-controlled communities are benign, functional, and perfectly OK," Bollier says. "It's just that the terms of services those companies have or the competitive pressures of business may compel them to take steps that are not in the interest of the community."

As a user of both Blogger and Facebook, I found this piece a bit unsettling and very thought provoking.

Thursday, September 10, 2009

Health care and consensus decision making

Last night I went to the beautiful Belle Isle Public Library to watch President Barack Obama address a joint session of Congress on the topic of health care reform. Call me a socialist if you will, but I really enjoy and appreciate this excellent government-run service (both the wi-fi in particular and the library in general). I sat there with my laptop and my earphones, and frantically took not-very-good handwritten notes. Which probably wasn't necessary, given that it's possible to read the transcript here or view the video here.

I need to start by saying that I have a lot of policy disagreements with the president about health care. I think we need single payer. I'm disappointed that the proposed public option is only open to those who don't already have health insurance. The version of the public plan originally proposed by Jacob Hacker would have covered anyone who wanted it, and would have done a lot more to control insurance costs. And despite the president's assurances, I'm worried that people without much money would be required to pay more than they could afford for the health care insurance that they'll be required to have. Senate Finance Committee Max Baucus's framework is particularly worrisome in that regard. And frankly, I think it's a bad thing that federal money can't be used to pay for abortion.

That being said, I think that it was a masterful speech by a masterful consensus builder. The word "masterful" makes me want to get out some Julia Penelope on the topic of patriarchal language, but that is a topic for a different time.

I do want to talk a little bit about consensus.

Watching the president, I was reminded of old meetings of, oh, say, the Oregon Women's Land Trust. If you've ever been part of a lesbian feminist organization that runs on consensus decision making, you will know that the US Congress has nothing on lesbian activists when it comes to getting into down-and-dirty political fights. The Senate, in particular, has rules that are very reminiscent of consensus decision making used by lesbian feminist collectives. Having a simple majority is enough to get something passed. While one person can't shut down the Senate (and I have more than once seen a single dissenter shut down a lesbian collective from taking any action), you need to have 60 votes to cut off debate in order to proceed with a bill.

By its nature, it's a conservative process. The way the Senate operates probably has most of the same advantages and disadvantages of consensus decision making. One big disadvantage is that a minority can bolix up the works and keep actions from being taken that have majority support. This is what's happening in the Senate right now. Especially after the death of Ted Kennedy, the president and the Democrats can't count on 60 votes to move forward without courting Republicans and conservative Democrats.

But the disadvantage is also an advantage. The truth is, if you have a substantial minority of the population that opposes a law that has passed, that law has much less chance of succeeding. It seems to me that the most successful movements of our times--the civil rights movements, the feminist movements--have been the most successful when campaigns to pass legislation were combined with campaigns to achieve popular support. Changing laws is not enough without changing people's hearts and minds. Sometimes the piece of legislation fails, but the change in popular attitudes that came about by fighting for it makes an enormous positive difference. I'm thinking of the Equal Rights Amendment here.

Okay, okay, I'll try to get back on track. Health care legislation is not the same as civil rights legislation, and to make a change, we do need to pass a law. I'm just trying to make the point that to pass the legislation and to have it succeed, President Obama needs to bring people together and build a broad base of support for it, including from moderate and conservative members of the population. And I think that's exactly what he succeeded in doing with his speech last night. He took the things that just about everybody agrees about, and used that as a basis for moving forward.

He gave an eloquent description of exactly how broken our current system is. How we are the only advanced democracy that doesn't offer universal health care. How people who don't have insurance--because they are self-employed and can't afford it, because they have a pre-existing condition that won't allow them to get coverage--can be just one accident or illness away from bankruptcy. How people who have insurance can find that their coverage has been dropped just when they need it the most. How we spend one and a half times more per person on healthcare per person without that making us any more healthy. How health insurance premiums are rising in cost three times faster than wages, and how this puts workers and businesses at a disadvantage. How increasing health care costs are putting "an unsustainable burden on the taxpayers."
When health care costs grow at the rate they have, it puts greater pressure on programs like Medicare and Medicaid. If we do nothing to slow these skyrocketing costs, we will eventually be spending more on Medicare and Medicaid than every other government program combined. Put simply, our health care problem is our deficit problem. Nothing else even comes close.
What the president did with the first part of his speech was to demonstrate that we do have a national consensus about what is wrong with the way we pay for health care. What he did next was to address what we need to do to fix it. His strategy was to position himself as being what he always has been, a centrist.
There are those on the left who believe that the only way to fix the system is through a single-payer system like Canada's...where we would severely restrict the private insurance market and have the government provide coverage for everybody. On the right, there are those who argue that we should end employer-based systems and leave individuals to buy health insurance on their own.
(Oregon Democratic Senator Ron Wyden has also proposed a plan that would end employer-based coverage and retain a private market, and might have been surprised to hear himself classified as being "on the right," but I suppose that is also a topic for another time.)

At any rate, having established that there is widespread agreement about what is wrong with our healthcare system, Obama argued that there is also widespread agreement--within Congress, at least--about many steps that need to be taken to correct the situation. And he argued that there has actually been significant progress toward creating reform legislation.
We've seen many in this chamber work tirelessly for the better part of this year to offer thoughtful ideas about how to achieve reform. Of the five committees asked to develop bills, four have completed their work, and the Senate Finance Committee announced today that it will move forward next week. That has never happened before. Our overall efforts have been supported by an unprecedented coalition of doctors and nurses; hospitals, seniors' groups, and even drug companies -- many of whom opposed reform in the past. And there is agreement in this chamber on about 80 percent of what needs to be done, putting us closer to the goal of reform than we have ever been.
According to the president, these points of agreement are:
  • People who already have health insurance through an employer or through Medicare, Medicaid, or the VA, would get to keep what they already have. (Although, as Matt Taibbi points out, if the insurance you get through your employer now is really awful, you would still be stuck with it.)
  • People who have insurance could not have their coverage canceled or "watered down." There could be no yearly or lifetime limits on coverage. There would be a limit on out-of-pocket expenses. Insurers would be required to cover routine checkups and tests such as colonoscopies or mammograms.
  • Individuals and small businesses that don't currently have access to affordable insurance would have access to something called a health insurance exchange. Because all these people would be pooled together as one group, they would have (at least in theory) the kind of collective bargaining power that government and large businesses now have. Insurance companies would participate in this system because it would give them access to millions of new potential customers.
  • Individuals and small businesses that still couldn't afford the insurance offered by these exchanges would receive subsidies based on their ability to pay.
  • Large businesses would be required to provide insurance for their employees. Most individuals would be required to purchase health insurance. There would be hardship waivers for individuals who couldn't afford insurance, and 95 percent of small businesses would be exempt.
While I continue to have serious reservations about the health care policies he's proposing, I have to admire the way he is putting his experience as a community organizer to good use. His strategy here seems almost like a page out of Building United Judgment. I think he's absolutely correct that even most conservative Republicans already agree with much of what he's proposing. For instance, when I attended Mary Fallin's town hall meeting back in August, one thing that struck me was how many of the things she said she supported were actually in the one of the existing health care bills, whether she was aware of this or not.

After showing how much agreement Congress already has about health insurance reform, the president openly confronted the orchestrated right-wing backlash to reform that developed over the summer.
Some of people's concerns have grown out of bogus claims spread by those whose only agenda is to kill reform at any cost. The best example is the claim made not just by radio and cable talk show hosts, but by prominent politicians, that we plan to set up panels of bureaucrats with the power to kill off senior citizens. Now, such a charge would be laughable if it weren't so cynical and irresponsible. It is a lie, plain and simple. (Applause.)
There are also those who claim that our reform efforts would insure illegal immigrants. This, too, is false. The reforms -- the reforms I'm proposing would not apply to those who are here illegally.
AUDIENCE MEMBER: You lie! (Boos.)
THE PRESIDENT: It's not true. And one more misunderstanding I want to clear up -- under our plan, no federal dollars will be used to fund abortions, and federal conscience laws will remain in place. (Applause.)
The heckler in this excerpt was reported to be Republican Rep. Joe Wilson of South Carolina.

The president went on to confront claims that his plan represented a "government takeover" of health care. Here is where I had my most ambivalent feelings. I'm as skeptical of government as the next person, but I think there are some services that don't operate well as private industries, and I think health insurance is one of those. The president actually made a similar point in his defense of the limited public option that four of the five committees working on health care have included in their bills:
My guiding principle is, and always has been, that consumers do better when there is choice and competition. That's how the market works. (Applause.) Unfortunately, in 34 states, 75 percent of the insurance market is controlled by five or fewer companies. In Alabama, almost 90 percent is controlled by just one company. And without competition, the price of insurance goes up and quality goes down. And it makes it easier for insurance companies to treat their customers badly -- by cherry-picking the healthiest individuals and trying to drop the sickest, by overcharging small businesses who have no leverage, and by jacking up rates.
Insurance executives don't do this because they're bad people; they do it because it's profitable. As one former insurance executive testified before Congress, insurance companies are not only encouraged to find reasons to drop the seriously ill, they are rewarded for it. All of this is in service of meeting what this former executive called "Wall Street's relentless profit expectations."
I don't think the limited public option in the healthcare bills before Congress does much to address the relentless profit-seeking of private insurers. It's only available to people who don't have insurance who are shopping for coverage through the exchange, and the president himself says that maybe five percent of people will be covered by it.

I think it's proper and necessary that some essential services--like health care--need to be made available for the public good, and not for the relentless profit expectations of Wall Street. I agree with Jeff Cohen that if Obama--or at least the liberal groups who are his allies--has started out pushing for a single-payer plan, we might have been able to win a strong public option that would have helped provide quality care at an affordable price. Now we are left with a situation in which Obama gives a ringing endorsement of a limited public plan, but says he's willing to trade it away.
Now, it is -- it's worth noting that a strong majority of Americans still favor a public insurance option of the sort I've proposed tonight. But its impact shouldn't be exaggerated -- by the left or the right or the media. It is only one part of my plan, and shouldn't be used as a handy excuse for the usual Washington ideological battles. To my progressive friends, I would remind you that for decades, the driving idea behind reform has been to end insurance company abuses and make coverage available for those without it. (Applause.) The public option -- the public option is only a means to that end -- and we should remain open to other ideas that accomplish our ultimate goal. And to my Republican friends, I say that rather than making wild claims about a government takeover of health care, we should work together to address any legitimate concerns you may have. (Applause.)
Okay. There was more of the president's speech that I haven't addressed. I don't have a grand concluding statement. But I think I've gone on about long enough, and it's almost time for me to go to work. My reaction to the president's speech remains contradictory.

On the one hand, I have serious concerns about what the president has proposed, and don't think the final bill will address those concerns. I think if progressive groups had worked harder and smarter for a more far-reaching proposal, we would have gotten a better result.

On the other hand, there is the reality of powerful right-wing opposition to health care reform to deal with, and we can't ignore that or merely wish it away. The right wing in this country remains extremely powerful, not necessarily because of whatever popular support it might have, but because it is extremely wealthy, well-organized, and well-connected. Obama's plan may be a realistic way to deal with that. I was moved by his sincerity last night, and impressed by his skill. Maybe what we have here is a good starting place. He says he hopes he is the last president to deal with health reform, but I hope he's wrong. What we have is a good first step on a very long journey.

Wednesday, September 9, 2009

Senate Finance Committee releases proposed healthcare "framework"

Conservative Democratic Senator Max Baucus of the Senate Finance Committee has released a proposed framework for a health care reform bill. Baucus and his bipartisan "gang of six" have been working to create a plan that at least some Republicans could support.

The semi-liberal Ezra Klein thinks the bill isn't great, but isn't bad.
Insofar as the effort is aimed at filling in the cracks of the current system — making it more affordable, more transparent and less cruel — it's not a bad bill.

The legislation really would protect millions of Americans from medical bankruptcy. It really would insure tens of millions of people. It really will curb the worst practices of the private insurance industry. It really will expand Medicaid and transform it from a mish-mash of state regulation into a dependable benefit. It really will lay down out-of-pocket caps which are a lot better than anything people have today. It really will help primary care providers, and it really will make hospitals more transparent, and it really will be a step towards paying for quality rather than volume.

Over at Health Beat, Maggie Mahar is less favorably impressed:
Finally, if insurers can charge 50-somethings five times as much as they charge 20-somethings (who the Baucus plan refers to as “young invincibles”), a great many of them are going to need subsidies. More tax-dollars winging their way to Aetna.

But wait, there is a loophole here: “An exemption [from mandate that everyone buy insurance] is permitted if coverage is deemed unaffordable – defined based on a circumstance where the lowest cost premium available exceeds 10% of a person’s income.”  Okay, here’s the answer for 50-somethings that just can’t afford paying five times as much as younger customers: we excuse them from the program. No penalty, no mandate. In other words, we don’t cover them at all—at the point in their life when they are most likely to need heath care.

Somehow, this isn’t what I thought they meant by “universal coverage.”

Oh, and in case you wondered.  . . No, there is no public sector insurance option in the Baucus plan. The private sector insurance industry will have a monopoly on the millions of new customers who will be coming their way, tax subsidies in hand.
Meanwhile, Truthdig asks Does Max Baucus Represent Montana or Blue Cross? Certainly a reasonable question. If you'd like to formulate your own opinion, you can read the 18-page framework for yourself, or compare it to other versions of health reform making their way through Congress.

Monday, September 7, 2009

Cynical but accurate?

Thanks to the folks at the Facebook "Boycott Whole Foods" group for posting a link to Matt Taibbi's Rolling Stone blog post about the health care reform process. I've read some of Taibbi's writing before on AlterNet, and I'm not sure I trust him. In the past, my impression has been that Taibbi is something of an arrogant blowhard. Some of that arrogance comes across in this piece, but underneath his self-righteousness and bad language, this is also a comprehensive history of the health care bills making their way through Congress.

Here's a sample:
To recap, here's what ended up happening with health care. First, they gave away single-payer before a single gavel had fallen, apparently as a bargaining chip to the very insurers mostly responsible for creating the crisis in the first place. Then they watered down the public option so as to make it almost meaningless, while simultaneously beefing up the individual mandate, which would force millions of people now uninsured to buy a product that is no longer certain to be either cheaper or more likely to prevent them from going bankrupt. The bill won't make drugs cheaper, and it might make paperwork for doctors even more unwieldy and complex than it is now. In fact, the various reform measures suck so badly that PhRMA, the notorious mouthpiece for the pharmaceutical industry which last year spent more than $20 million lobbying against health care reform, is now gratefully spending more than seven times that much on a marketing campaign to help the president get what he wants.

So what's left? Well, the bills do keep alive the so-called employer mandate, requiring companies to provide insurance to their employees. A good idea — except that the Blue Dogs managed to exempt employers with annual payrolls below $500,000, meaning that 87 percent of all businesses will be allowed to opt out of the best and toughest reform measure left. Thanks to Harry Reid, Nancy Pelosi and Barack Obama, we can now be assured that the 19 or 20 employers in America with payrolls above $500,000 who do not already provide insurance will be required to offer good solid health coverage. Hurray!

The rest of the piece is a bit long, but I think this is necessary in order for Taibbi to do justice to a complicated subject. I would really be interested in any comments that you have afterward.

Friday, September 4, 2009

If you think health care reform is bad, consider the alternative

Thanks to Maggie Mahar at Health Beat for writing up a two-part post by Joe Paduda at Managed Care Matters. These two posts consider what the consequences are likely to be if health care reform fails to pass Congress.

Part One of "Your life without healthcare reform" is here. In this part, Paduda relies on a report at to predict what will happen to health care costs if we don't get a health care bill that includes strong cost controls. Paduda says:
When costs increase ten percent a year, they double every seven years. With current family premiums in the $15,000 range, employers and employees will be paying $30,000 per family in 2016. And that's not including deductibles and copays, which are sure to rise.

If you're relying on so-called consumer-directed health plans to stem the tide, good luck - their costs went up two points more than 'regular' HMO and PPO plans. Industry veterans aren't surprised, as new insurance products almost always have good experience in the first couple years and as the block 'ages', claims creep up. As I've noted previously, CDHPs are not a panacea, in fact they may well drive up costs due to delayed care. (That said, with substantial changes CDHPs could be a valuable tool in cost containment.)

Eventually the US will reform its health insurance and health care delivery 'systems'. Unfortunately I don't see it happening this year due to the failure of the Democrats to put forth a program that controls costs, make a cogent argument and control the debate, and the decision by the Republicans to remain nothing more than the 'Party of No'.

In Part Two, Paduda argues that
The past is a pretty good predictor of the future; over the last eight years cost have consistently increased more than ten percent each year, with most increases well above that level. Whether we are at the bottom of the cycle or cost inflation rates will continue to decrease is unclear, but what is clear is that the inflation rate will head back up at some point in the next few years.
Back to the real world impact.
  • If nothing changes, the share of the nation's budget paid by the government will be greater than that paid thru private insurers.
  • 178,000 small business jobs will be lost by 2018 as a result of health care costs
  • If employee contributions stay at their current level (about 30% of premiums), workers will be paying $9000 per year, or $750 per month, towards their health coverage - not including deductible, copays, coinsurance, and services not covered
  • General Motors' health insurance will add about $3000 to the cost of each vehicle - if it is still in business
  • In my hometown of Madison, Conn., Town employee health insurance costs are paid for with property taxes; without reform the amount of tax revenue needed to pay those bills will double by 2016, forcing tax increases and/or significant serice cuts
  • More Americans will have to rely on the kindness of others for their health care
  • Because 65 million of us will be without health insurance
Unlike the distortions, misrepresentations, and outright lies being spread by McCaughey, Limbaugh, Palin et al, this is the real deal. So fight against reform if you wish, but don't complain later when you can't afford insurance, your employer can't afford insurance, your taxes are going up to pay for teachers' benefits, and our economy is sinking under the weight of health care costs.

Paduda thinks the right wing will win this battle but lose the war, because eventually, without health care reform, too many of us will be in too much pain to tolerate the status quo. For my own part, I am hoping that the battle is not lost, and that with luck and hard work, we can prevent the pain that Paduda predicts.

Wednesday, September 2, 2009

They hate government run health care, but they choose to use it

Sam Stein at the Huffington Post reports that GOPers Decrying "Socialized Medicine" Go To Govt. Hospital For Surgeries.

The Republicans in question are senators John McCain, (R-Ariz.), Senator Kit Bond (R-Mo.), Senator George Voinovich, (R-Ohio), and Rep. Roy Blunt, (R-Mo.) . All have chosen to receive treatment at Bethesda Naval Hospital--which members of Congress are able to do if they pay an annual fee.

As Stein points out:
To be strictly accurate, there is an important distinction between a government-run hospital and a government-run health insurance agency. The public plan, which is the focus of much of the GOP's ire, is the latter. Bethesda Naval Hospital is the former.

But conservatives have long used the notion of "socialized medicine" to defeat health care reform efforts -- even though when it comes to the flagship Naval Hospital just miles away, the worries about bureaucratic nightmares, low quality care, and long lines seem to be wiped away.